Ramblings of an Emergency Physician in Texas

“Doctor, I’m having chest pain…”

…was the chief complaint of a nice fellow the other evening, but in Spanish, so there was a lot of hand waving and pointing going on. He looked a little familiar, but I couldn’t place him or his spouse. (An aside: I recognize faces fairly often, but not the context in which I saw them, so this isn’t unusual for me, at all).

An hour or so later, as some of the (completely normal) test results were coming back, I had the requested old records and a professional interpreter, so we went back to the patients’ room.

As the interpreter is going back through the complaint, allergies, etc., I’m scanning the most recent admission history, and realize this was my patient three weeks ago. Not just that, this patient required CPR twice while in the ED, and I spent about an hour at the bedside then, working hard to keep him alive. No wonder he looked a little familiar.

So, we return to the chief complaint, ‘chest pain’, and it’s chest wall pain, worse with deep breaths. He says it’s been getting better since he ‘woke up’ about a week ago, but it still bothered him, and the family made him come in a get it checked out, as they’d had plenty of worries about him already.

I explained to him what had happened ‘while he was out’, and described the CPR he’d gotten. That was the first he’d known of that, and was more than a little surprised. So, his chest pain was caused by CPR. He was relieved, and went home to follow up with his doctor.

The family was very gratifyingly grateful, which makes me uncomfortable in some weird way. I’m used to criticism and disappointment from patients, and I tend to shrug off the occasional compliment. This was no different, but it did make me feel good that what we do in the ED had really made a difference, had saved this man with a family who cared for him, and that except for some chest wall pain he was doing great!

The rest of that shift was terrific. Sometimes chest pain can be a reminder that it’s good to be alive.

Comments

It’s amazing how used to abuse we get and how gratitude makes us uncomfortable. I lapped a gunshot victim the other night and fixed a couple of small bowel holes, no big deal. Actually it was a simple case and the intern did most of it while I kept him out of trouble. When I went to the waiting room to let the family know that the guy was going to be ok they started clapping, shouting and cheering. Well as a egotistical surgeon I had often felt that a particularly good operation deseved applause and that if second tier rock bands have groupies, I should too. So much for that — I was so uncomfortable, embarassed, and nonplussed I almost ran away. If they had been yelling at me, I would have known how to deal with it. Bizarre

I went to the ER in Midland on 22 December with upper back pains. Within 6 hours was scheduled for by-pass surgery that evening. After being anesthesized I had to wait 8 hours whilst my surgeon attended to an emergency admitance in Odessa who came in clinically dead. It was worth the effort on my part. Dr. Patel saved the other patients life….and my surgery turned out fine.

I once had an ER patient (late middle aged woman) with chest wall pain, which eventually turned out to have been due to the CPR the family performed on her at home before they brought her to the ER. The patient herself did not recall this had happened, and was not aware that she had recently blacked out. I actually spoke to several members of the family during the patient’s workup. They had witnessed or taken part in the CPR, but did not see fit to tell me. They only disclosed this apparently minor detail when I was on the point of sending the patient home. Bit of an embarrassment there.